Implant microflora/endodontic courses

Implant And Other ProsthesisImplant And Other Prosthesis
Related Microflora ChangesRelated Microflora Changes
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

ContentsContents
Introduction
Microbial colonization of the mouth
Microbiota around stable implants
Microbiota around failing implants
Effect of mucosal clinical variables and
bone level on microflora
Other prosthesis related microflora
changes
Conclusion
References

IntroductionIntroduction
Microorganisms are continuously
introduced into the oral cavity.
Grouping of organisms at sites in which
they can flourish and establishment in
different niches.

IntroductionIntroduction
As more species become established ,
the opportunity for new species
becomes limited and a degree of
stability may be attained.
Upon the insertion of prosthesis this
stability may be disrupted.

Microbial ColonizationMicrobial Colonization
ofof
the Mouththe Mouth

A. naeslundii
Gram +ve cocci & rods
A. gerencseriae
S.oralis
P.micros
Gram -ve anaerobic rods (13%)

Microbial colonization of the mouthMicrobial colonization of the mouth
Decreased Cocci and increased No. of Motile Rods And Spirochetes

Porphyromonas Gingivalis,Porphyromonas Gingivalis,
A.actinomycetemcomitansA.actinomycetemcomitans
Bacteroides Forsythus,Bacteroides Forsythus,
AndAnd
Species Of Prevotella, Fusobacterium, CampylobacterSpecies Of Prevotella, Fusobacterium, Campylobacter
& Treponema Have Been Detected& Treponema Have Been Detected

Other bacteria associated with
periodontal destruction include:
– Fusobacterium nucleatum
– Campylobacter rectus
– P micros
– Treponema denticola
– Treponema vincentii

Following full mouth tooth extraction,
changes occur in the tissues and / or
surfaces that are available for
microorganism adherence.
When patients with severe periodontits
become edentulous,
A actinomycetemcomitans and
P gingivalis are no longer detectable

Within a month after full mouth tooth
extraction, suggesting that their primary
habitat is the dentition or the
periodontal sulcus.
Furthermore, a marked reduction or
even elimination of Spirochetes, as well
as a reduction in Lactobacilli, yeasts ,
Streptococcus mutans, and

Streptococcus sanguis occurs in
edentulous adults with or without
conventional removable dentures
compared to dentate patients.
Seems that no significant
periodontopathic flora capable of
constituting a risk factor for implants,is
left after full mouth extraction.

Microbiota Around Stable ImplantsMicrobiota Around Stable Implants

Microbiota of Stable ImplantsMicrobiota of Stable Implants
Gram Positive
Facultative Cocci
Non Motile Rods
S sanguis and S mitis are the most predominant organisms

INFREQUENT
Motile Rods
Spirochetes,
Fusiforms &
Filaments
A actinomycetemcomitans & P gingivalis  seldom detectedP intermedia and P nigrescens are more common

The microflora that is present in the oral
cavity before implant placement
determines the composition of the
newly establishing microflora around
implants.
Implants with signs of deterioration
show a microbiota resembling that of
adult or refractory periodontitis.

Microbiota Around FailingMicrobiota Around Failing
ImplantsImplants

Gram negative
anaerobic rods Fusobacteria
P intermedia
Spirochetes
P.micros
P. intermedia
C.rectus
P. gingivalis
B.forsythus

Microbiota of Failing ImplantsMicrobiota of Failing Implants
Presence of periodontal pathogens
Development of Peri-implantitis
Presence of other co-factors is required as well.
Local or systemic circumstances are needed

Microbiota of Failing ImplantsMicrobiota of Failing Implants
It seems realistic to conclude that it is
possible to place implants with
acceptable rates in periodontal patients
as long as the number of potential
periodontal pathogens is kept at a low
level and co-factors are in normal limits.

Effect of Mucosal Clinical VariablesEffect of Mucosal Clinical Variables
and Peri-implant Bone Leveland Peri-implant Bone Level

Plaque Index,
Bleeding Index,
Gingival Index,
Probing Pocket Depth
Probing Pocket Depth

Few studies have reported on the
microbiota of implants with peri-implant
bone defects.
-could not be related specifically to the
presence of certain microorganisms,
but certain microorganisms were
detectable or present at higher levels in
perimplant bone defects

Local circumstances ( oral hygiene,
bone defects, deep pockets, overload)
as well as systemic conditions
(diabetes, smoking, genetic factors)
maybe contributing factors.

Hypothesis postulated
Microorganisms act as promoters or
catalysts in implant failure, but they
need a suitable environment.

Other Prosthesis RelatedOther Prosthesis Related
Microflora ChangesMicroflora Changes

C. albicans most frequent (62.1% )
Gram-positive cocci
C. albicans, C. glabrata and C. tropicalis

Other Prosthesis Related ChangesOther Prosthesis Related Changes
Patients With
Prosthetic Stomatitis Higher
Patients Without
Prosthetic Stomatitis Lower
Plaque Index And The Frequency Of Yeasts
Candida albicans was 10 times higher in DIS patients

Other Prosthesis Related ChangesOther Prosthesis Related Changes
Staph. aureus
S sanguis
S mutans
Lactobacilli

Cocci Filamentous

Spirochetes
Motile Forms

Stable Implants
S sanguis and S mitis MOST
PREDOMINANT
P intermedia and P nigrescens are
more common
Gram Positive Facultative Cocci
Non Motile Rods
INFREQUENT
Motile Rods Spirochetes, Fusiforms
& Filaments;
A actinomycetemcomitans & P
gingivalis  seldom detected
Failing Implants
P intermedia, Fusobacteria and
spirochetes
P micros, P intermedia, C rectus,
species

ConclusionConclusion
The microflora of the oral cavity prior to
implantation determines the
composition of the flora in the peri-
implant area.
The microflora around stable implants
resembles that of the subgingival flora
of healthy dentate patients.

microflora of peri-implantitis lesions
resembles that of adult or refractory
periodontitis.
Potential pathogens present in the oral
cavity do not necessarily act as peri-
implant pathogens

Various prosthesis may provide means
of mechanical attachment to the
microflora.
This in turn allows their aggregation and
colonization
Bielby’s layer or providing smooth
polished surfaces may reduce microbial
colonization.

ReferencesReferences
Microbiota around root form endosseous implants: a review
of literature
Int j Oral Maxillofac Implants 2002; 17:829-38
The oral microbiota of man from birth to senility. J
Periodontol 1971;42:485-96
Short term effect of full mouth extraction on periodontal
pathogens colonizing the oral mucous membranes. J Clin
Periodontol 1994;21:484-89
Development of dental plaque on epoxy resin crowns in man.
A light and electron microscopic study.
J Periodontol.1975;46:10-26
Bacterial involvement in denture induced stomatitis. J Dent
Res 1988 ;67(9):1246-50

ReferencesReferences
Denture plaque- past and recent concerns.
J Dent.1998;26(4):299-304.
Are certain oral pathogens part of normal oral flora in denture
wearing edentulous subjects?
Oral-Microbiol-Immunol.1991;6(2):119-22
Cultivable microflora of plaque from full denture bases and
adjacent palatal mucosa.
J-Biol-Buccale.1985;13(3)227-36

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Implant microflora/endodontic courses

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